Nasopharyngeal cooling during resuscitation: randomized study

Introduction

Nasopharyngeal cooling during cardiopulmonary resuscitation has been shown to ease the resuscitation effort and to improve the resuscitation rate, survival and neurologic outcome in porcine models of both prolonged ventricular fibrillation and pulseless electrical activity arrest. The aim of this study was to determine whether nasopharyngeal cooling initiated during resuscitation improves the resuscitation rate (return of spontaneous circulation (ROSC)), survival and neurologic outcome.

Methods

The study is ongoing. Cooling was performed using a novel device (RhinoChill; BeneChill, Inc., San Diego, CA, USA) that sprays a volatile coolant into the nasal cavity. Patients were randomized to nasopharyngeal cooling during resuscitation or no cooling in the field, followed by cooling for all patients in hospital. All patients with witnessed arrest and a downtime less than 20 minutes deemed eligible for resuscitation were included. Nasopharyngeal cooling was initiated either before or after defibrillation and was continued until systemic cooling could be initiated. Patients who had achieved ROSC were excluded. Resuscitation was continued until ROSC was achieved or for 30 minutes.

Results

Five patients were randomized to treatment and six were controls. ROSC was achieved in five out of five (100%) treated patients but in only three out of six (50%) controls. All five (100%) treated patients survived to hospital admission as compared with one out of six (16.7%) controls. At 24 hours, three out of five (60%) treated patients were alive as compared with none of the controls. The first treated patient who completed the 1-week evaluation was neurologically intact.

Conclusion

Nasopharyngeal cooling initiated during resuscitation may improve the ROSC rate and survival to 24 hours. The impact of this treatment on long-term survival and neurologic outcome remains to be determined.